Provider Demographics
NPI:1306830021
Name:HEDVAT, YAHYA (MD)
Entity Type:Individual
Prefix:DR
First Name:YAHYA
Middle Name:
Last Name:HEDVAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18065 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3517
Mailing Address - Country:US
Mailing Address - Phone:818-708-6163
Mailing Address - Fax:818-708-6167
Practice Address - Street 1:18055 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3517
Practice Address - Country:US
Practice Address - Phone:818-881-8117
Practice Address - Fax:818-996-8972
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2008-07-23
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAA86664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine